This ethnographic study will focus on the work and the interactions of a group of clinical practitioners employed within a multicultural mental health care institution. More specifically, the anthropological technique of participant observation will be combined with structured interviews and questionnaires to examine: (1) the influence that ethnicity and culture have on the development of clinical knowledge and practice within a professional mental health care subsector of an American Indian health care system; and (2) the bureaucratic and organizational contexts that inform the construction of clinical reality by the professional practitioners who work in this subsector. The primary setting will be the Mental Health Clinic at the Northern Navajo Medical Center on the Navajo Nation Reservation in Shiprock, New Mexico. The main sample will consist of all Native and non Native persons employed in this Indian Health Service (IHS) outpatient clinic throughout the duration of the study. The ethnographer will use Kleinman's cross-cultural model of the health care system to articulate the particular arrangements of social institutions and patterns of interpersonal interactions that impinge upon the practitioners view of clinical reality. In accordance with the first aim, this research will explain how the mental health practitioners tailor a Euro-American nosological system, that traditionally disregards culture specific presentations of distress, to the needs of an American Indian clientele. The study will also investigate whether practitioners are integrating DSM-IV's new outline for cultural formulation and other cultural features into their existing repertoire of diagnostic and treatment practices. In pursuit of the second aim, the ethnographer will clarify issues which concern how mental health practitioners, of diverse professional training and ethnic/cultural backgrounds function as a collective with particular responsibilities that have been given by the IHS and the Navajo Tribal community. This study will indicate the extent to which these health care providers incorporate views on ethnicity and the "culture" of their clients into their clinical activities and it will provide them with a different perspective on their work routines. The methods employed and the models of multicultural interaction generated in this small-scale study will be fundamental to the development of comparative ethnographic investigations of health care providers in other IHS institutions. Because of its particular emphasis on the multiplicity of cultures and bureaucratic contexts that affect mental health services geared to American Indians. this research will also prove useful in the formation of future training programs that orient providers to the practical issues they will face while working within a multicultural medical setting.